Diagnosis and embolizing of spinal arteriovenous malformations.
Spinal arteriovenous malformations are uncommon disorders associated with considerable difficulty in diagnosis and treatment. They are divided into dural arteriovenous fistulas and intradural medullary spinal cord angiomas. In this retrospective series of six patients the clinical outcome of embolization is presented. The patient material consisted of three dural fistulas and three cord angiomas, one of which bled causing sudden paresis, pain and incontinence. In the remaining five patients the symptoms were progressive consisting of paraesthaesias, paraparesis, pain and incontinence. The clinical status of four patients was not changed after the treatment, one deterioriated and one improved. There were no bleedings after the therapy. In one patient spinal angiography for follow-up was performed and recanalization was seen in the dural fistula after particle embolization. Also, in one cord angioma embolized with particles reflow appeared in the immediately repeated angiography. For permanent angioma occlusion tissue adhesive is preferred as embolic material. Surgical therapy as an alternative or adjuvant to embolization is discussed with a review of the literature. Early timing of the therapeutic intervention is stressed to avoid the development of irreversible ischaemic medullopathy and to prevent haemorrhage. The therapeutic procedures at the early stage of the disease may be curable or, at least, halt the progression of the symptoms. Cross-sectional imaging studies and myelographies may reveal the lesion. For the definitive diagnosis of spinal angioma with its vascular feeders and for the evaluation of its occlusion grade after the therapy selective spinal angiography is needed.
Kähärä
V J
VJ
Department of Radiology, Tampere University Hospital, Finland. vkahara@tays.fi
Seppänen
S K
SK
Kuurne
T
T
Laasonen
E M
EM
D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013116:Spinal Cord / Q000098:blood supply* / Q000473:pathology; D013382:Subtraction Technique